CA2176565C - Visually directed trocar and method - Google Patents
Visually directed trocar and methodInfo
- Publication number
- CA2176565C CA2176565C CA002176565A CA2176565A CA2176565C CA 2176565 C CA2176565 C CA 2176565C CA 002176565 A CA002176565 A CA 002176565A CA 2176565 A CA2176565 A CA 2176565A CA 2176565 C CA2176565 C CA 2176565C
- Authority
- CA
- Canada
- Prior art keywords
- light transmission
- imaging member
- trocar
- light
- surgical
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Expired - Lifetime
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/00064—Constructional details of the endoscope body
- A61B1/00071—Insertion part of the endoscope body
- A61B1/0008—Insertion part of the endoscope body characterised by distal tip features
- A61B1/00087—Tools
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/00131—Accessories for endoscopes
- A61B1/00135—Oversleeves mounted on the endoscope prior to insertion
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/36—Image-producing devices or illumination devices not otherwise provided for
- A61B90/37—Surgical systems with images on a monitor during operation
- A61B2090/373—Surgical systems with images on a monitor during operation using light, e.g. by using optical scanners
Landscapes
- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Surgery (AREA)
- Animal Behavior & Ethology (AREA)
- Public Health (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Heart & Thoracic Surgery (AREA)
- Medical Informatics (AREA)
- Molecular Biology (AREA)
- Pathology (AREA)
- General Health & Medical Sciences (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Veterinary Medicine (AREA)
- Physics & Mathematics (AREA)
- Biophysics (AREA)
- Optics & Photonics (AREA)
- Radiology & Medical Imaging (AREA)
- Endoscopes (AREA)
- Surgical Instruments (AREA)
- Apparatus For Radiation Diagnosis (AREA)
- Laser Surgery Devices (AREA)
Abstract
This invention is a new and improved laparoscopic trocar (21) and sleeve assembly in which the trocar (21) is provided with a transparent tip (22) that can include a blade edge (78), and accommodates a light telescope (24) for supplying a video console, so that while the trocar (21) is being surgically inserted through the abdominal wall and into the abdominal cavity, visualization on the video console will be possible to avoid injury to blood vessels in the abdominal cavity or injury to any of the internal organs located in the abdominal cavity. A handle (32, 33) provided on the trocar (21) facilitates manipulation and control of the trocar tip (22) penetration. Once clear visualization is established, conventional laparoscopic procedures can be carried out safely.
Description
2~
Wo 95113751 Pcr/rTss4/08683 VISUALLY DIRECTED TROCAR AND METHOD
T. FTrT.n This invention relates to the field of operative and diagnostic laparoscopic surgical ~L;ICI~ ULaS and in particular to a new and; _ ~-v~d visually directed trocar laparoscopic in~LL, L and method of use for ct~nrlllct i n~ such procedures .
BA~ KU~ OF 'rTTT~ ~ r.V~
Operative and diagnostic laparoscopy is the most commonly performed surgical pLuce-luLe: in the United States today. Therefore, any complication associated with this procedure poses a major public health concern.
Conventional known laparoscopic procedures usually are carried out as follows:
1. An in_ ~L ~ L known as the Veress needle is blindly inserted 2 0 through the navel into the ;~h~ll ;nAl cavity of a patient.
2. Carbon dioxide is delivered blindly through the Veress needle into the abdomen.
Wo 95113751 Pcr/rTss4/08683 VISUALLY DIRECTED TROCAR AND METHOD
T. FTrT.n This invention relates to the field of operative and diagnostic laparoscopic surgical ~L;ICI~ ULaS and in particular to a new and; _ ~-v~d visually directed trocar laparoscopic in~LL, L and method of use for ct~nrlllct i n~ such procedures .
BA~ KU~ OF 'rTTT~ ~ r.V~
Operative and diagnostic laparoscopy is the most commonly performed surgical pLuce-luLe: in the United States today. Therefore, any complication associated with this procedure poses a major public health concern.
Conventional known laparoscopic procedures usually are carried out as follows:
1. An in_ ~L ~ L known as the Veress needle is blindly inserted 2 0 through the navel into the ;~h~ll ;nAl cavity of a patient.
2. Carbon dioxide is delivered blindly through the Veress needle into the abdomen.
3. A laparoscopy trocar assembly comprised by a trocar and trocar sleeve is blindly inserted through the navel into and through the ilhrl~--inAl wall of the Ah-ll ;nAl cavity.
4. The trocar is withdrawn from the trocar sleeve and a light telescope with light source placed in the leev~ thus ~ting V; ~ ; 7~tion of the interior of the cavity possible.
5. Once clear vi ~ 1 i 7~tion is established a variety of surgical IJL OCe~luL e:S can be carried out safely through the central opening in the trocar sleeve with remotely operable surgical il-s,LLI Ls in a conventional known manner.
There are 6everal reports in the medical literature that the f irst two steps of a laparoscopic procedure as outlined above can be omitted, and the laparoscopic trocar assembly be directly inserted blindly into the Ah~l~ i n:-l cavity. Results of these papers indicate that 1 ications can still be expected since the entry through the ;~hr9~ ; n~ 1 cavity wall into the Ihd~ ;n~l cavity remains blind.
BrTMMD12Y OF TH~ u~
It is therefore a primary purpose of this invention to make available a new and i uved, visually directed, laparoscopic in~LL, L which allows the laparoscopic surgeon to enter the Ah~l~ in;~l or other cavity of a patient under direct vision. This visually directed laparoscopic procedure will eliminate most if not all major and minor complications as60ciated with the blind invasive surgical te~!hni qn~
presently employed in laparoscopic ~LuceduL~s as described above.
In practicing the invention a new and i, uved laparoscopic in~,LL, L is provided with an elongated, hollow trocar having a tipped end suitable for insertion through layers of human skin and flesh forming the walls of a cavity with the tipped end being fabricated from light transparent material. The tipped end of light transparent material preferably is shaped to form a light tra=smission and imaging element for ~1 7656~:
projecting light outwardly into an Ahd~ ;nAl or other cavity of a patient, and for receiving back and directing light images onto a suitable light image receptor of a conventional miniaturized light telescope designed for surgical purpose6. The tipped end of light transparent material is formed to pierce human flesh. In other embo~ Ls, a cutting member which can be formed of metal or ceramic for example, is adapted to cooperate with the tipped end of light transparent material to provide the tipped end with a cutting edge for piercing human flesh to permit surgical insertion of the tipped end through human flesh and into a body cavity.
The hollow trocar has a central passageway formed therein of sufficient diameter to ~ te the elements of a miniaturized light telescope together with essential power supply conductors for energizing the light source and light receptors such as a bundle of fiber optic light coupling elements for deriving and providing back light images usable for laparoscopic diagnostic procedures even while the trocar is being surgically inserted through the navel and is penetrating through the layers of l:kin and A~-' ;nA~
wall of a patient and on into the A~ ' ; n:~l cavity.
In preferred ~ s of the invention, the laparoscopic in,,~L, ~ includes a hollow tubular trocar sleeve that ~ULL~UlldS and encloses the trocar for a substantial portion of its length to form a combined trocar and sleeve assembly. The trocar is slidable lengthwise relative to the trocar sleeve whereby the trocar can be removed after visually controlled physical ~l~t L of the trocar and sleeve assembly into the A'-' ;nAl wall of a patient's AhCIllm;nAl cavity at a desired location and to a desired depth. The trocar then can be replaced with a - ;.aL
large fiber optic light telescope and video imaging system, and other remotely manipulatable surgical wo ~ 1 ~ 6 5 6 . 4 PC rluS94/08683 --in~,~L, L inserted through the central opening of the trocar sleeve in a conventional known manner.
The invention makes available a new and improved laparoscopic ~LuceduLe: comprising mounting a miniaturized light telescope with light source together with suitable miniaturized power supply conductors, and fiber optic coupling and light receptor elements in the hollow trocar prior to starting the l~aL~ ~c.,~ic procedure. The light telescope then is energized from an electric power source and the output of the light receptors supplied to a video display. Following this setup, the tipped and lighted end of the trocar with or without the cutting member is placed at a point, such ~s the navel, on a patient ' s abdomen to be penetrated 1~ while ob6erving such pl Ir L on the video display.
The cutting member may appear as a line or narrow band on the video display and does not obscure vision through the light transparent material. The lighted trocar then is surgically inserted by being pressed slowly and carefuliy into and through the walls of the patient's abdomen while observing the yL~yLeaa of the trocar assembly as it travels into and through the wall of the ;Ih~l~ i n;~ 1 or other cavity . During this process, the operator, by properly controlling orientation and ~1~>YL~SS of the trocar tip, can assure that the trocar does not penetrate into the ~Ih-ll in;~l cavity at a place or for a distance where it might injure any blood vessels within the ~' in;~ll cavity walls or internal organs within the Ahd~ ; n;l 1 cavity . A handle provided on the trocar facilitates ~-~n;p~ tion and control of the trocar tip penetration.
8RIEF DE~:scl~ OF DRaWI~G8 These and other objects, features and many of the attendant advantages of this invention will be appreciated more readily as the same becomes better understood from a reading of the following detailed wo 95113751 2 1 7 6 5 6 S PcrluS94/08683 description, when considered in connection with the ac- ying drawings, wherein like parts in each of the several figures are identified by the same ref erence characters, and wherein:
Figure 1 iB a side elevational view of a know, combined trocar and sleeve assembly with trumpet valve and stopcock ~ -c:l~Ls constructed according to the prior art;
Figure 2 is a side elevational view of a known trocar sleeve having a different trumpet valve construction from the assembly shown in Figure 1 and built according to the prior art;
Figure 3 is a side elevational view of a known trocar design suitable for use with the sleeve lS shown in Figure 2 and built according to the prior art;
Figure 4 is a longitudinal sectional view of a new and; uv~:d trocar having a transparent tipped end constructed according to the invention;
Figure 5 is a longitudinal view of a hollow trocar sleeve suitable for use with the new and improved trocar shown in Figure 4;
Figure 6 is a longitudinal sectional view of a new and; ~ ~ vt:d combined hollow trocar and sleeve assembly employing the elements of Figures 4 and 5, and 2 5 constructed in accordance with the invention;
Figure 7 is a longitudinal sectional view of an alternative form of a new and; _~,v~d hollow trocar having extra eYterior handles constructed according to the invention;
Figure 8A is a side elevational view of another ~ of a new and improved hollow trocar with an alternative form of handle, the opposite side of the handle being symmetrical to the side shown;
Figure 8B is an end view of Flgure 8A as taken from the handle end of Figure 8A;
WO 9S/13751 2 ~ .6 $ PCT~S94/08683 --Figure 9 ~is~àn'end view of the tipped end of the new and i uv~d hollow trocar showing an alternative form of the tipped end;
Figure 10 is a fragmentary sectional view taken on the line 10-10 of Figure g;
Figure 11 i5 an enlarged detail section taken on the line 11-11 of Figure 10;
Figure 12 is an end view of the tipped end of the new and; _ uved hollow trocar showing a further alternative form of the tipped end;
Figure 13 is a rL_ ~ary sectional view taken on the line 13-13 of Figure 12;
Figure 14 is one version of an enlarged detail section taken on the line 14-14 of Figure 13;
and Figure 15 is another version of an enlarged detail section taken on the line 14-14 of Figure 13.
~E8~ ~ûDE OF PRaCTICIN~ T~r lh ~
As noted earlier in the brief description of the drawings, Figures 1, 2 and 3 of the drawings illustrate a prior art, known trocar and sleeve assembly now being used by the medical profession in performing laparoscopic procedures such as laparoscopic cholecystectomies. Other similar laparoscopic procedures can be performed using the in,, L-, L . In these drawings, Figure 1 is an elevational side view of ~ known combined trocar and trocar sleeve assembly 11 comprised by an elongated, solid, 5tAinl~s~ steel trocar 12, best seen in Figure 3, and a hollow, tubular trocar sleeve 15 shown in Figure 2. Trocar 12 includes a pointed tipped end 13, which may be either pyramidal or the like or conical in configuration, and is sufficiently sharp to be able to pelleLLe-~e and be physically pressed through the navel, layers of skin and Ah~r-inAl walls of a patient in order to provide access to the interior of the Ah~l~ inAl cavity. Trocar wo 95113751 217 ~ ~ 6 5 PCTIUS94/086~13 12 is a solid rod of ~l~yLoLLiate diameter, for example of from 6 to 9 mi 11; ' ~rs in diameter, and terminates in a push cap 14 that facilitates surgical insertion of the stif f elongated rod 12 into and through the navel of a patient by pushing on cap 14.
The trocar 12 is physically supported within the trocar sleeve 15 shown in Figure 2 of the drawings.
Trocar sleeve 15 is a cylindrical hollow tube fabricated from biologically compatible material, such as stainless steel. Sleeve 15 has a central opening into which the trocar 12 fits in a relatively tight manner, but is sufficiently loose to allow trocar 12 to be slid lengthwise relative to the sleeve 15 and withdrawn. Trocar sleeve 15 in most applications also includes at least one trumpet valve 16 as shown in both Figures ~ and 2 as well as one or more insufflation stopcocks shown at 17 in Figure 2. These elements all are of known cu.luLLuuLion and operation and need not be described in detail with respect to the present invention. In use the assembled trocar and sleeve appear as shown at 11 in Figure 1 of the drawings.
As described earlier in the specification, conventional 1e-~aI usc ul.ic procedure is carried out by first blindly inserting a Veress (not shown) through the navel into the Ah~l~ i nAl cavity of the patient.
Carbon dioxide gas then is delivered blindly through the Veress needle into the abdomen in an effort to draw the skin of the abdomen on which the navel is ~ po~d away from any organs resting int~rnAlly within the AhA~min~l cavity and to improve visualization within the cavity. It is at this point that the lapa.u6cu~ic trocar and sleeve assembly 11 is blindly inserted through the navel into the Ah~l~ ini~l cavity.
After insertion of the trocar and sleeve assembly 11, the trocar 12 is withdrawn from the trocar sleeve 15 leaving the sleeve with its Arp"n~d elements such as the trumpet valve 16 and in~l~fflAtion stopcock Wo 95/137~1 PCr/USs4108683 --2176~i65 ` 8 17 extending into the Ah-' ;n~l cavity. A light telescope with a miniaturized light source of conventional commercially available construction is inserted through the central opening of the trocar sleeve 15 to establish v; f llAl; 7ation of the intra-~hd ;nAl organs. Once clear Yisualization is established, a variety of surgical plc,ce~uL~s can be carried out safely through the use of remotely operable surgical in~,LL Ls lnserted into the interior of the Ah,l,)m;nAl cavity through the central passageway in the trocar sleeve 15 in a known manner. Upon completion of the procedures, all in ,Ll_ -ntS including the light telescope are withdrawn along with the trocar sleeve and the opening through which they were inserted is sewn up.
It is believed apparent that the step of introducing the trocar and sleeve assembly into the ~hrlr-inAl cavity using conventional known terhn;que~, is a blind pLo~ luL~ and r~ e~utllLly causes injury to blood vessels in the walls of the Ah~l~ ;nAl cavity and organs located within the Ah~ ;nAl cavity close to the point of entry.
In order to avoid possible injury to the blood vessels and/or internal organs, the present invention was devised and is illustrated in Figure 4, Figure 5 and Figure 6 of the drawings together with Figures 7 through Figure 15 which show alternative constructions of the trocar according to the invention.
Figure 4 is a longitudinal sectional view taken along the longitudinal axis of an elongated, cylindrically-shaped trocar having a hollow tubular body 21 fabricated from an inflexible material (such as stainless steel) that is compatible with human flesh.
Trocar 21 has a tipped end 22 that is su~ficiently sharp that it can be surgically inserted through layers ~ ~kin and ~aL f1_ by ph, ically pres--ing ~ ~
217656~ -Wo 95/1375~ PCT/US94/08683 push cap 23 secured to the opposite end of the trocar.
Tipped end 22 is fabricated from light transparent material such as glass or a space-age plastic and is shaped to form a light transmission and imaging element for projecting light outwardly into an At-' ;nAl or other cavity of a patient and for directing light images received back onto a suitable light image receptor 24. Tipped end 22 also has a substantially solid piercing point, as shown in Figure 4, which can be of pyramidal or the like or conical configuration.
As shown in Figures 4 and 7, for example, a tapered portion of the tipped end 22 proj ects from the tubular body 21 and a non-tapered portion of the tipped end 22 is recessed in the tubular body 21.
Light image receptor 24 is part of a commercially available, miniaturized, medical light telescope for surgical use and is not part of this invention. Receptor 24 may comprise a plurality of light receiving input ends of a bundle of fiber optic light coupling elements (not shown~ or alternatively a S~mi cnT~ tor light to electric signal trAnRcluc~r.
Trocar 21 ha6 a central opening 25 which is of sufficient diameter to Al_ ~Ate pa68age of the elements of the miniaturized light t~ ccope such a6 a light source 26 comprised by a bundle of fiber optic elements, a semic~ - L laser or a light bulb together with essential power supply conductors and/or fiber optic light coupling elements (not shown). These elements serve to energize light source 26 and light receptors 24 (or L~ r8 if required) together with f iber optical or electric signal co~lrl; ng elements for deriving and supplying video signals to a video camera 27, comprising a part of the light telescope system.
The video camera 27 excites a suitable video monitor (not shown) for producing video images usable for diagnostic and surgical purposes even while the trocar is being surgically inserted into and is penetrating Wo 95/13751 PcrlUss4/o8683 --21 7656S lo the layers of skin on the navel prior to procePrl; n~
into the Ah~ ; nFI 1 cavity .
Trocar 21 shown in Figure 4 is designed for use with a trocar sleeve 28 shown in Figure 5. Trocar sleeve 28 comprises an elongated hollow tubular body of stainless steel or other similar material having an open end through which the tipped transparent end 22 of trocar 21 project6 and a rubber sealing cap 29 on the opposite end. Preferably a trumpet valve 16 and insufflation stopcock, such as 17 shown in Figure 2, are included on the hollow trocar sleeve 28. If desired, the trocar sleeve 15 shown in Figure 2 and trocar sleeve 28 in Figure 5 can be made to be interrh~ngeAhle .
Trocar sleeve 28 is designed to physically r.ULLUUlld and enclose trocar 21 for a substantial portion of its length to form a combined trocar and sleeve assembly shown in Figure 6 of the drawings. The trocar 21 is slidable lengthwise relative to trocar sleeve 28 so that the trocar can be removed after visual surgical insertion of the trocar 21 and sleeve 28 assembly into the ;~h-l- ;n:~l cavity of a patient at a desired location and to a desired depth. After removal of trocar 21, it is replaced with a suitable known fiber optic light source and video imaging system (not shown) and supplemented with other remotely manipulatable surgical in,,l_L, Ls (not shown) which can be inserted through the central opening of the trocar sleeve 28 in a conventional, known manner.
Figure 7 lllustrates an alternative design of the trocar 21 wherein suitable handles shown at 32 and 33 are provided on opposite sides of the elongated tubular body of the trocar 21 at the end opposite transparent tip end 22. In all other respects, the trocar of Figure 7 is similar to that described with relation to Figure 4. Surgical insertion of the trocar 21 of Figure 7 and trocar sleeve 28 in assembled Wo ~5113751 2 1 7 6 5 6 ~ PCTrUS94rO8683 relation as depicted by Figure 6, through the navel of a patient can be better ~ h~d and more easily guided using the handles 32 and 33 while visually observing the pI~y~eSS of the trocar through the layers of skin and Ahd~ in:~l walls of a patient. By observing the pre-imminent entry of the trocar assembly into the i~lhrl~ inAl cavity under conditions where the position of blood vessels in the walls of the Ah~ ; nA 1 cavity and internal organs located within the Al- ' ;n~l cavity can be observed, prior to thru6ting the trocar all the way into the cavity, injury to the blood vessels and internal organs can be avoided.
Figures 8A and 8B illustrate another alternative design of the trocar 21. A handle 36, preferably formed of plastic, is affixed at or proximate an end 38 of the trocar 21, opposite the tipped end 22. As shown in Figure 8A, the handle 36 extends away from the trocar 21 so as to avoid interference with the central opening 25 at the trocar end 38. The handle 36 includes a finger contour portion 40 to A:_ '~te the individual fingers and is sufficiently elongated to permit gripping by all of the fingerS. A thumb flange 42 is provided on each side of the handle 36 for right or left handed users to rest their thumb during exertion of manual pL~:SDULe: on the trocar 21 in the direction of the tipped end 22. The handle 36 further includes a mounting portion 44 adjacent the thumb flange 42 which encircle6 the trocar at the end 3 8 and can be bonded or otherwise secured to the trocar end 38.
Figure 9 illustrates an alternative design of the tipped end 22 as used on the trocar 21. The tipped end 22, which is shown for example as a three-sided pyramidal tip, is combined with a cutter member 50.
The cutter member 50, which can be formed of a suitable hardened material such as stainless steel or ceramic for example, includes V-shaped (in cross-section) Wo 95/13751 PCr/US94/08683 cutting portions 52, 54 and 56 that wrap onto the pyramidal corners of the tipped end 22 as shown in Figure 11. Each of the cutting portions 52, 54 and 56 have sharp edges that converge to a common sharp point 60 as shown in Figure 9. An annular reinforcing ring 62 joins the cutting portions 52, 54 and 56.
The cutting member 50 can be formed as a separate member and placed as an insert in a mold for molding the tipped end 22 from plastic. Alternatively the cutting member 50 and the tipped end 22 can be separately formed and bonded together with a suitable know medical grade adhesive.
The cutting member 50 can also be modified to include four cutting portions for inuc,L~ uLc.tion in a tipped end 22 of a four-sided pyramidal configuration.
In addition, the cutting member 50 can be inauL~uLc~Led in a tipped end 22 of conical configuration, wherein the cutting edges 58 project slightly from the curved conical surface.
Figure 12 illustrates a further alternative design of the tipped end 22 as used on the trocar 21.
The tipped end 22, which is shown for example as a three-sided pyramidal tip, is combined with a cutter member 70. The cutter member 70, which can be formed of stainless steel or ceramic for example, includes bar-like cutting portions 72, 74 and 76 that are partly A; ~:po~ed within the tipped end 22 in ~ L with the pyramidal corners of the tipped end as shown in Figure 14. Each of the cutting portions 72, 74 and 76 have sharp edges 78 that ac,l.veLy~: to a common sharp point 80 as shown in Figure 12.
The cutting portions 72, 74 and 76 can be ;mhe~d in the tipped end 22 up to the sharp edge 78 as shown in Figure 14 or the sharp edge 78 can project slightly as shown in Figure 15.
The cutting member 70 can also be modified to include four cutting portions for incorporation in a ;
~vo 95/137~ 7 6 5 ~ 5 PcT/USs4/08683 tipped end 22 of four-sided pyramidal configuration.
In addition, the cutting member 70 can be incorporated in a tipped end of conical configuration in the aLL~ such as shown in Figures 14 or 15.
Molding of a tipped end 22 with the cutting member 70 18 in accordance with the manner previously described for the tipped end 22 of Figures 9-11.
If desired, the conical tipped end 22 can include a cutting member 50 or 70 that has a single cutting portion extending across opposite sides of the conical tipped end.
Also, if desired, the cutting members 50 and 70 need not extend to the pointed extremity of the tipped end 22, thereby ~nAhl ing the pointed extremity of the tipped end 22 to pass light.
In conducting a laparoscopic procedure employing the novel, hollow, laparoscopic trocar 21 with a tipped end 22 fabricated from light transparent material shaped to form a light tr~n~ sinn and receiving element with or without a cutting member, the pl~,ceduL~ is ~ ~ by activating the miniaturized light telescope including the light source and suitable miniaturized light receptors, power supply conductors and fiber optic couplings provided in the assembled hollow trocar and sleeve, while using the trocar of any of Figures 4-15, prior to starting the pLuceduL~.
After the light source is activated, any output from the light receptors 24 is supplied to a video display console (not shown) via video receiver 27. ~he tipped and lighted end of the trocar 21 then is placed at the point on the patient's abdomen (such as the navel) to be penetrated while ob6erving such pl 1, ~ on the video display. The trocar and sleeve assembly then is pushed slowly into and through the layers of skin and support flesh of the patient's navel while observing the prc,yL~ss of the trocar assembly on the video display while it travels into and through the navel.
76~6~
Wo 95/13751 21 PCT/US94/08683 In using the trocar with the cutting members 50 or 70, the cutting edges appear as lines or narrow bands and do not obscure vision through the light telescope and do not obscure the video display. During the in6ertion process, the positioning of the trocar can be adjusted by the laparoscopic surgeon, if n~Cc~cc;~ry, by manipulation of the push cap 23 and/or side handles 32 and 33, or the handle 36, to assure that the trocar does not penetrate into the Ah~ ; nAl cavity at a place or for a distance where it might penetrate and injure blood vessels in the walls of the cavity or internal organs within the ithar~m; n:~ll cavity.
In the above recited ~Locedu~, the combined assembly-of trocar 21 and trocar sleeve 28 are inserted together with the light source and video display ~ ?-~ts of the miniaturized light telescope contained therein. After completing the visually ectecl insertion of the combined trocar and sleeve assembly as described above, the trocar 21 together with its light source and video display -ntS is removed from sleeve 28 which remains implanted in the ~- ;n:~l cavity. The trocar 21 then is replaced in implanted sleeve 28 with the fiber optic light source and video imaging system of the miniaturized light telescope along ~ith any other assorted remotely manipulatable surgical illaL~ ~ Ls, as needed, which are inserted through the central opening in the trocar sleeve in a conventional known manner.
pl~r ~Tr~ T. APPI~ICA~3ILITY
This invention provides to the medical profession a new laparoscopic illDLL~ L which allows the laparoscopic surgeon to enter the i~h~ ; n 11 cavity of a patient under conditions where he can directly, visually follow the progress of the pointed tip of the inaL,, as it passes through the layers of skin and supporting walls of the ~_a ;ns~l cavity. Hence, prior wogsll37sl 2~7B~65 PCr/US94108683 ' 15 to entering the Ah~ ; nA1 cavity to any great depth, the surgeon can observe whether there are any blood vessels in the supporting walls or internal organs which would be ~ull~ LuL ~d or otherwise damaged if the trocar is allowed to pe~ LL-te too deeply at a selected point. The new yL~.;e-lu~ ~: and inDLL~ L will eliminate many major and minor complications associated with the prior known blind invasive laparoscopic surgical techniques employed to implant the laparoscopic trocar and sleeve assembly into the Ah~ ;nAl cavity.
Having described several ~ Ls of a new and; ~ ~uv~d laparoscopic inDLL, -nt and pL.,ce,luL.~
according to the invention, it is believed obvious that other modif ications and variations of the invention will be suggested to those skilled in the art in the light of the above t~A~h;n~s. It i5 therefore to be understood that changes may be made in the particular : ';r- - Ls of the invention described which are within the full intended scope of the invention as defined by the appended claims.
There are 6everal reports in the medical literature that the f irst two steps of a laparoscopic procedure as outlined above can be omitted, and the laparoscopic trocar assembly be directly inserted blindly into the Ah~l~ i n:-l cavity. Results of these papers indicate that 1 ications can still be expected since the entry through the ;~hr9~ ; n~ 1 cavity wall into the Ihd~ ;n~l cavity remains blind.
BrTMMD12Y OF TH~ u~
It is therefore a primary purpose of this invention to make available a new and i uved, visually directed, laparoscopic in~LL, L which allows the laparoscopic surgeon to enter the Ah~l~ in;~l or other cavity of a patient under direct vision. This visually directed laparoscopic procedure will eliminate most if not all major and minor complications as60ciated with the blind invasive surgical te~!hni qn~
presently employed in laparoscopic ~LuceduL~s as described above.
In practicing the invention a new and i, uved laparoscopic in~,LL, L is provided with an elongated, hollow trocar having a tipped end suitable for insertion through layers of human skin and flesh forming the walls of a cavity with the tipped end being fabricated from light transparent material. The tipped end of light transparent material preferably is shaped to form a light tra=smission and imaging element for ~1 7656~:
projecting light outwardly into an Ahd~ ;nAl or other cavity of a patient, and for receiving back and directing light images onto a suitable light image receptor of a conventional miniaturized light telescope designed for surgical purpose6. The tipped end of light transparent material is formed to pierce human flesh. In other embo~ Ls, a cutting member which can be formed of metal or ceramic for example, is adapted to cooperate with the tipped end of light transparent material to provide the tipped end with a cutting edge for piercing human flesh to permit surgical insertion of the tipped end through human flesh and into a body cavity.
The hollow trocar has a central passageway formed therein of sufficient diameter to ~ te the elements of a miniaturized light telescope together with essential power supply conductors for energizing the light source and light receptors such as a bundle of fiber optic light coupling elements for deriving and providing back light images usable for laparoscopic diagnostic procedures even while the trocar is being surgically inserted through the navel and is penetrating through the layers of l:kin and A~-' ;nA~
wall of a patient and on into the A~ ' ; n:~l cavity.
In preferred ~ s of the invention, the laparoscopic in,,~L, ~ includes a hollow tubular trocar sleeve that ~ULL~UlldS and encloses the trocar for a substantial portion of its length to form a combined trocar and sleeve assembly. The trocar is slidable lengthwise relative to the trocar sleeve whereby the trocar can be removed after visually controlled physical ~l~t L of the trocar and sleeve assembly into the A'-' ;nAl wall of a patient's AhCIllm;nAl cavity at a desired location and to a desired depth. The trocar then can be replaced with a - ;.aL
large fiber optic light telescope and video imaging system, and other remotely manipulatable surgical wo ~ 1 ~ 6 5 6 . 4 PC rluS94/08683 --in~,~L, L inserted through the central opening of the trocar sleeve in a conventional known manner.
The invention makes available a new and improved laparoscopic ~LuceduLe: comprising mounting a miniaturized light telescope with light source together with suitable miniaturized power supply conductors, and fiber optic coupling and light receptor elements in the hollow trocar prior to starting the l~aL~ ~c.,~ic procedure. The light telescope then is energized from an electric power source and the output of the light receptors supplied to a video display. Following this setup, the tipped and lighted end of the trocar with or without the cutting member is placed at a point, such ~s the navel, on a patient ' s abdomen to be penetrated 1~ while ob6erving such pl Ir L on the video display.
The cutting member may appear as a line or narrow band on the video display and does not obscure vision through the light transparent material. The lighted trocar then is surgically inserted by being pressed slowly and carefuliy into and through the walls of the patient's abdomen while observing the yL~yLeaa of the trocar assembly as it travels into and through the wall of the ;Ih~l~ i n;~ 1 or other cavity . During this process, the operator, by properly controlling orientation and ~1~>YL~SS of the trocar tip, can assure that the trocar does not penetrate into the ~Ih-ll in;~l cavity at a place or for a distance where it might injure any blood vessels within the ~' in;~ll cavity walls or internal organs within the Ahd~ ; n;l 1 cavity . A handle provided on the trocar facilitates ~-~n;p~ tion and control of the trocar tip penetration.
8RIEF DE~:scl~ OF DRaWI~G8 These and other objects, features and many of the attendant advantages of this invention will be appreciated more readily as the same becomes better understood from a reading of the following detailed wo 95113751 2 1 7 6 5 6 S PcrluS94/08683 description, when considered in connection with the ac- ying drawings, wherein like parts in each of the several figures are identified by the same ref erence characters, and wherein:
Figure 1 iB a side elevational view of a know, combined trocar and sleeve assembly with trumpet valve and stopcock ~ -c:l~Ls constructed according to the prior art;
Figure 2 is a side elevational view of a known trocar sleeve having a different trumpet valve construction from the assembly shown in Figure 1 and built according to the prior art;
Figure 3 is a side elevational view of a known trocar design suitable for use with the sleeve lS shown in Figure 2 and built according to the prior art;
Figure 4 is a longitudinal sectional view of a new and; uv~:d trocar having a transparent tipped end constructed according to the invention;
Figure 5 is a longitudinal view of a hollow trocar sleeve suitable for use with the new and improved trocar shown in Figure 4;
Figure 6 is a longitudinal sectional view of a new and; ~ ~ vt:d combined hollow trocar and sleeve assembly employing the elements of Figures 4 and 5, and 2 5 constructed in accordance with the invention;
Figure 7 is a longitudinal sectional view of an alternative form of a new and; _~,v~d hollow trocar having extra eYterior handles constructed according to the invention;
Figure 8A is a side elevational view of another ~ of a new and improved hollow trocar with an alternative form of handle, the opposite side of the handle being symmetrical to the side shown;
Figure 8B is an end view of Flgure 8A as taken from the handle end of Figure 8A;
WO 9S/13751 2 ~ .6 $ PCT~S94/08683 --Figure 9 ~is~àn'end view of the tipped end of the new and i uv~d hollow trocar showing an alternative form of the tipped end;
Figure 10 is a fragmentary sectional view taken on the line 10-10 of Figure g;
Figure 11 i5 an enlarged detail section taken on the line 11-11 of Figure 10;
Figure 12 is an end view of the tipped end of the new and; _ uved hollow trocar showing a further alternative form of the tipped end;
Figure 13 is a rL_ ~ary sectional view taken on the line 13-13 of Figure 12;
Figure 14 is one version of an enlarged detail section taken on the line 14-14 of Figure 13;
and Figure 15 is another version of an enlarged detail section taken on the line 14-14 of Figure 13.
~E8~ ~ûDE OF PRaCTICIN~ T~r lh ~
As noted earlier in the brief description of the drawings, Figures 1, 2 and 3 of the drawings illustrate a prior art, known trocar and sleeve assembly now being used by the medical profession in performing laparoscopic procedures such as laparoscopic cholecystectomies. Other similar laparoscopic procedures can be performed using the in,, L-, L . In these drawings, Figure 1 is an elevational side view of ~ known combined trocar and trocar sleeve assembly 11 comprised by an elongated, solid, 5tAinl~s~ steel trocar 12, best seen in Figure 3, and a hollow, tubular trocar sleeve 15 shown in Figure 2. Trocar 12 includes a pointed tipped end 13, which may be either pyramidal or the like or conical in configuration, and is sufficiently sharp to be able to pelleLLe-~e and be physically pressed through the navel, layers of skin and Ah~r-inAl walls of a patient in order to provide access to the interior of the Ah~l~ inAl cavity. Trocar wo 95113751 217 ~ ~ 6 5 PCTIUS94/086~13 12 is a solid rod of ~l~yLoLLiate diameter, for example of from 6 to 9 mi 11; ' ~rs in diameter, and terminates in a push cap 14 that facilitates surgical insertion of the stif f elongated rod 12 into and through the navel of a patient by pushing on cap 14.
The trocar 12 is physically supported within the trocar sleeve 15 shown in Figure 2 of the drawings.
Trocar sleeve 15 is a cylindrical hollow tube fabricated from biologically compatible material, such as stainless steel. Sleeve 15 has a central opening into which the trocar 12 fits in a relatively tight manner, but is sufficiently loose to allow trocar 12 to be slid lengthwise relative to the sleeve 15 and withdrawn. Trocar sleeve 15 in most applications also includes at least one trumpet valve 16 as shown in both Figures ~ and 2 as well as one or more insufflation stopcocks shown at 17 in Figure 2. These elements all are of known cu.luLLuuLion and operation and need not be described in detail with respect to the present invention. In use the assembled trocar and sleeve appear as shown at 11 in Figure 1 of the drawings.
As described earlier in the specification, conventional 1e-~aI usc ul.ic procedure is carried out by first blindly inserting a Veress (not shown) through the navel into the Ah~l~ i nAl cavity of the patient.
Carbon dioxide gas then is delivered blindly through the Veress needle into the abdomen in an effort to draw the skin of the abdomen on which the navel is ~ po~d away from any organs resting int~rnAlly within the AhA~min~l cavity and to improve visualization within the cavity. It is at this point that the lapa.u6cu~ic trocar and sleeve assembly 11 is blindly inserted through the navel into the Ah~l~ ini~l cavity.
After insertion of the trocar and sleeve assembly 11, the trocar 12 is withdrawn from the trocar sleeve 15 leaving the sleeve with its Arp"n~d elements such as the trumpet valve 16 and in~l~fflAtion stopcock Wo 95/137~1 PCr/USs4108683 --2176~i65 ` 8 17 extending into the Ah-' ;n~l cavity. A light telescope with a miniaturized light source of conventional commercially available construction is inserted through the central opening of the trocar sleeve 15 to establish v; f llAl; 7ation of the intra-~hd ;nAl organs. Once clear Yisualization is established, a variety of surgical plc,ce~uL~s can be carried out safely through the use of remotely operable surgical in~,LL Ls lnserted into the interior of the Ah,l,)m;nAl cavity through the central passageway in the trocar sleeve 15 in a known manner. Upon completion of the procedures, all in ,Ll_ -ntS including the light telescope are withdrawn along with the trocar sleeve and the opening through which they were inserted is sewn up.
It is believed apparent that the step of introducing the trocar and sleeve assembly into the ~hrlr-inAl cavity using conventional known terhn;que~, is a blind pLo~ luL~ and r~ e~utllLly causes injury to blood vessels in the walls of the Ah~l~ ;nAl cavity and organs located within the Ah~ ;nAl cavity close to the point of entry.
In order to avoid possible injury to the blood vessels and/or internal organs, the present invention was devised and is illustrated in Figure 4, Figure 5 and Figure 6 of the drawings together with Figures 7 through Figure 15 which show alternative constructions of the trocar according to the invention.
Figure 4 is a longitudinal sectional view taken along the longitudinal axis of an elongated, cylindrically-shaped trocar having a hollow tubular body 21 fabricated from an inflexible material (such as stainless steel) that is compatible with human flesh.
Trocar 21 has a tipped end 22 that is su~ficiently sharp that it can be surgically inserted through layers ~ ~kin and ~aL f1_ by ph, ically pres--ing ~ ~
217656~ -Wo 95/1375~ PCT/US94/08683 push cap 23 secured to the opposite end of the trocar.
Tipped end 22 is fabricated from light transparent material such as glass or a space-age plastic and is shaped to form a light transmission and imaging element for projecting light outwardly into an At-' ;nAl or other cavity of a patient and for directing light images received back onto a suitable light image receptor 24. Tipped end 22 also has a substantially solid piercing point, as shown in Figure 4, which can be of pyramidal or the like or conical configuration.
As shown in Figures 4 and 7, for example, a tapered portion of the tipped end 22 proj ects from the tubular body 21 and a non-tapered portion of the tipped end 22 is recessed in the tubular body 21.
Light image receptor 24 is part of a commercially available, miniaturized, medical light telescope for surgical use and is not part of this invention. Receptor 24 may comprise a plurality of light receiving input ends of a bundle of fiber optic light coupling elements (not shown~ or alternatively a S~mi cnT~ tor light to electric signal trAnRcluc~r.
Trocar 21 ha6 a central opening 25 which is of sufficient diameter to Al_ ~Ate pa68age of the elements of the miniaturized light t~ ccope such a6 a light source 26 comprised by a bundle of fiber optic elements, a semic~ - L laser or a light bulb together with essential power supply conductors and/or fiber optic light coupling elements (not shown). These elements serve to energize light source 26 and light receptors 24 (or L~ r8 if required) together with f iber optical or electric signal co~lrl; ng elements for deriving and supplying video signals to a video camera 27, comprising a part of the light telescope system.
The video camera 27 excites a suitable video monitor (not shown) for producing video images usable for diagnostic and surgical purposes even while the trocar is being surgically inserted into and is penetrating Wo 95/13751 PcrlUss4/o8683 --21 7656S lo the layers of skin on the navel prior to procePrl; n~
into the Ah~ ; nFI 1 cavity .
Trocar 21 shown in Figure 4 is designed for use with a trocar sleeve 28 shown in Figure 5. Trocar sleeve 28 comprises an elongated hollow tubular body of stainless steel or other similar material having an open end through which the tipped transparent end 22 of trocar 21 project6 and a rubber sealing cap 29 on the opposite end. Preferably a trumpet valve 16 and insufflation stopcock, such as 17 shown in Figure 2, are included on the hollow trocar sleeve 28. If desired, the trocar sleeve 15 shown in Figure 2 and trocar sleeve 28 in Figure 5 can be made to be interrh~ngeAhle .
Trocar sleeve 28 is designed to physically r.ULLUUlld and enclose trocar 21 for a substantial portion of its length to form a combined trocar and sleeve assembly shown in Figure 6 of the drawings. The trocar 21 is slidable lengthwise relative to trocar sleeve 28 so that the trocar can be removed after visual surgical insertion of the trocar 21 and sleeve 28 assembly into the ;~h-l- ;n:~l cavity of a patient at a desired location and to a desired depth. After removal of trocar 21, it is replaced with a suitable known fiber optic light source and video imaging system (not shown) and supplemented with other remotely manipulatable surgical in,,l_L, Ls (not shown) which can be inserted through the central opening of the trocar sleeve 28 in a conventional, known manner.
Figure 7 lllustrates an alternative design of the trocar 21 wherein suitable handles shown at 32 and 33 are provided on opposite sides of the elongated tubular body of the trocar 21 at the end opposite transparent tip end 22. In all other respects, the trocar of Figure 7 is similar to that described with relation to Figure 4. Surgical insertion of the trocar 21 of Figure 7 and trocar sleeve 28 in assembled Wo ~5113751 2 1 7 6 5 6 ~ PCTrUS94rO8683 relation as depicted by Figure 6, through the navel of a patient can be better ~ h~d and more easily guided using the handles 32 and 33 while visually observing the pI~y~eSS of the trocar through the layers of skin and Ahd~ in:~l walls of a patient. By observing the pre-imminent entry of the trocar assembly into the i~lhrl~ inAl cavity under conditions where the position of blood vessels in the walls of the Ah~ ; nA 1 cavity and internal organs located within the Al- ' ;n~l cavity can be observed, prior to thru6ting the trocar all the way into the cavity, injury to the blood vessels and internal organs can be avoided.
Figures 8A and 8B illustrate another alternative design of the trocar 21. A handle 36, preferably formed of plastic, is affixed at or proximate an end 38 of the trocar 21, opposite the tipped end 22. As shown in Figure 8A, the handle 36 extends away from the trocar 21 so as to avoid interference with the central opening 25 at the trocar end 38. The handle 36 includes a finger contour portion 40 to A:_ '~te the individual fingers and is sufficiently elongated to permit gripping by all of the fingerS. A thumb flange 42 is provided on each side of the handle 36 for right or left handed users to rest their thumb during exertion of manual pL~:SDULe: on the trocar 21 in the direction of the tipped end 22. The handle 36 further includes a mounting portion 44 adjacent the thumb flange 42 which encircle6 the trocar at the end 3 8 and can be bonded or otherwise secured to the trocar end 38.
Figure 9 illustrates an alternative design of the tipped end 22 as used on the trocar 21. The tipped end 22, which is shown for example as a three-sided pyramidal tip, is combined with a cutter member 50.
The cutter member 50, which can be formed of a suitable hardened material such as stainless steel or ceramic for example, includes V-shaped (in cross-section) Wo 95/13751 PCr/US94/08683 cutting portions 52, 54 and 56 that wrap onto the pyramidal corners of the tipped end 22 as shown in Figure 11. Each of the cutting portions 52, 54 and 56 have sharp edges that converge to a common sharp point 60 as shown in Figure 9. An annular reinforcing ring 62 joins the cutting portions 52, 54 and 56.
The cutting member 50 can be formed as a separate member and placed as an insert in a mold for molding the tipped end 22 from plastic. Alternatively the cutting member 50 and the tipped end 22 can be separately formed and bonded together with a suitable know medical grade adhesive.
The cutting member 50 can also be modified to include four cutting portions for inuc,L~ uLc.tion in a tipped end 22 of a four-sided pyramidal configuration.
In addition, the cutting member 50 can be inauL~uLc~Led in a tipped end 22 of conical configuration, wherein the cutting edges 58 project slightly from the curved conical surface.
Figure 12 illustrates a further alternative design of the tipped end 22 as used on the trocar 21.
The tipped end 22, which is shown for example as a three-sided pyramidal tip, is combined with a cutter member 70. The cutter member 70, which can be formed of stainless steel or ceramic for example, includes bar-like cutting portions 72, 74 and 76 that are partly A; ~:po~ed within the tipped end 22 in ~ L with the pyramidal corners of the tipped end as shown in Figure 14. Each of the cutting portions 72, 74 and 76 have sharp edges 78 that ac,l.veLy~: to a common sharp point 80 as shown in Figure 12.
The cutting portions 72, 74 and 76 can be ;mhe~d in the tipped end 22 up to the sharp edge 78 as shown in Figure 14 or the sharp edge 78 can project slightly as shown in Figure 15.
The cutting member 70 can also be modified to include four cutting portions for incorporation in a ;
~vo 95/137~ 7 6 5 ~ 5 PcT/USs4/08683 tipped end 22 of four-sided pyramidal configuration.
In addition, the cutting member 70 can be incorporated in a tipped end of conical configuration in the aLL~ such as shown in Figures 14 or 15.
Molding of a tipped end 22 with the cutting member 70 18 in accordance with the manner previously described for the tipped end 22 of Figures 9-11.
If desired, the conical tipped end 22 can include a cutting member 50 or 70 that has a single cutting portion extending across opposite sides of the conical tipped end.
Also, if desired, the cutting members 50 and 70 need not extend to the pointed extremity of the tipped end 22, thereby ~nAhl ing the pointed extremity of the tipped end 22 to pass light.
In conducting a laparoscopic procedure employing the novel, hollow, laparoscopic trocar 21 with a tipped end 22 fabricated from light transparent material shaped to form a light tr~n~ sinn and receiving element with or without a cutting member, the pl~,ceduL~ is ~ ~ by activating the miniaturized light telescope including the light source and suitable miniaturized light receptors, power supply conductors and fiber optic couplings provided in the assembled hollow trocar and sleeve, while using the trocar of any of Figures 4-15, prior to starting the pLuceduL~.
After the light source is activated, any output from the light receptors 24 is supplied to a video display console (not shown) via video receiver 27. ~he tipped and lighted end of the trocar 21 then is placed at the point on the patient's abdomen (such as the navel) to be penetrated while ob6erving such pl 1, ~ on the video display. The trocar and sleeve assembly then is pushed slowly into and through the layers of skin and support flesh of the patient's navel while observing the prc,yL~ss of the trocar assembly on the video display while it travels into and through the navel.
76~6~
Wo 95/13751 21 PCT/US94/08683 In using the trocar with the cutting members 50 or 70, the cutting edges appear as lines or narrow bands and do not obscure vision through the light telescope and do not obscure the video display. During the in6ertion process, the positioning of the trocar can be adjusted by the laparoscopic surgeon, if n~Cc~cc;~ry, by manipulation of the push cap 23 and/or side handles 32 and 33, or the handle 36, to assure that the trocar does not penetrate into the Ah~ ; nAl cavity at a place or for a distance where it might penetrate and injure blood vessels in the walls of the cavity or internal organs within the ithar~m; n:~ll cavity.
In the above recited ~Locedu~, the combined assembly-of trocar 21 and trocar sleeve 28 are inserted together with the light source and video display ~ ?-~ts of the miniaturized light telescope contained therein. After completing the visually ectecl insertion of the combined trocar and sleeve assembly as described above, the trocar 21 together with its light source and video display -ntS is removed from sleeve 28 which remains implanted in the ~- ;n:~l cavity. The trocar 21 then is replaced in implanted sleeve 28 with the fiber optic light source and video imaging system of the miniaturized light telescope along ~ith any other assorted remotely manipulatable surgical illaL~ ~ Ls, as needed, which are inserted through the central opening in the trocar sleeve in a conventional known manner.
pl~r ~Tr~ T. APPI~ICA~3ILITY
This invention provides to the medical profession a new laparoscopic illDLL~ L which allows the laparoscopic surgeon to enter the i~h~ ; n 11 cavity of a patient under conditions where he can directly, visually follow the progress of the pointed tip of the inaL,, as it passes through the layers of skin and supporting walls of the ~_a ;ns~l cavity. Hence, prior wogsll37sl 2~7B~65 PCr/US94108683 ' 15 to entering the Ah~ ; nA1 cavity to any great depth, the surgeon can observe whether there are any blood vessels in the supporting walls or internal organs which would be ~ull~ LuL ~d or otherwise damaged if the trocar is allowed to pe~ LL-te too deeply at a selected point. The new yL~.;e-lu~ ~: and inDLL~ L will eliminate many major and minor complications associated with the prior known blind invasive laparoscopic surgical techniques employed to implant the laparoscopic trocar and sleeve assembly into the Ah~ ;nAl cavity.
Having described several ~ Ls of a new and; ~ ~uv~d laparoscopic inDLL, -nt and pL.,ce,luL.~
according to the invention, it is believed obvious that other modif ications and variations of the invention will be suggested to those skilled in the art in the light of the above t~A~h;n~s. It i5 therefore to be understood that changes may be made in the particular : ';r- - Ls of the invention described which are within the full intended scope of the invention as defined by the appended claims.
Claims (29)
1. A surgical penetration device comprising:
a) an inflexible elongated member having a first end, b) a light transmission and imaging member formed essentially of transparent material, provided at the first end of said elongated member to form an extension of said elongated member and project light and receive light images, c) cutting means including a cutting member cooperable with said light transmission and imaging member to provide said light transmission and imaging member with a cutting edge for piercing human flesh to permit surgical insertion of said light transmission and imaging member through human flesh into a body cavity, and d) said elongated member having means for containing a conventional lighting means and a conventional light image receiving means in the form of a conventional telescope to cooperate with said light transmission and imaging member, said containing means being sized to permit detachable slidable insertion of the conventional telescope in the elongated member and slidable removal of the conventional telescope from the elongated member.
a) an inflexible elongated member having a first end, b) a light transmission and imaging member formed essentially of transparent material, provided at the first end of said elongated member to form an extension of said elongated member and project light and receive light images, c) cutting means including a cutting member cooperable with said light transmission and imaging member to provide said light transmission and imaging member with a cutting edge for piercing human flesh to permit surgical insertion of said light transmission and imaging member through human flesh into a body cavity, and d) said elongated member having means for containing a conventional lighting means and a conventional light image receiving means in the form of a conventional telescope to cooperate with said light transmission and imaging member, said containing means being sized to permit detachable slidable insertion of the conventional telescope in the elongated member and slidable removal of the conventional telescope from the elongated member.
2. The surgical penetration device as claimed in claim 1 wherein said light transmission and imaging member has an outside surface and said cutting member is joined to the outside surface of said light transmission and imaging member.
3. The surgical penetration device as claimed in claim 1 wherein said light transmission and imaging member has an outside surface and said cutting member is adapted to extend beyond said outside surface to pierce human flesh and permit surgical insertion of said light transmission and imaging member through human flesh.
4. The surgical penetration device as claimed in claim 3 wherein said cutting member includes a blade edge projecting from said light transmission and imaging member.
5. The surgical penetration device as claimed in claim 1 wherein said cutting member includes a plurality of blade edges in intersecting planes.
6. The surgical penetration device as claimed in claim 1 wherein said light transmission and imaging member is formed of plastic and said cutting member is incorporated in said light transmission and imaging member.
7. The surgical penetration device as claimed in claim 6 wherein said cutting member includes a plurality of blade edges in intersecting planes projecting away from said light transmission and imaging member.
8. The surgical penetration device as claimed in claim 1 wherein said light transmission and imaging member has a sharp pointed tip.
9. The surgical penetration device as claimed in claim 1 wherein said light transmission and imaging member is affixed to said first end of said inflexible elongated member.
10. The surgical penetration device as claimed in claim 9 wherein said elongated member is hollow.
11. The surgical penetration device as claimed in claim 9 wherein said elongated member is a cylinder.
12. The surgical penetration device as claimed in claim 1 wherein said light transmission and imaging member has a light transmissible tapered section and a light transmissible nontapered section, a predetermined amount of said nontapered section being recessed in the first end of said elongated member.
13. The surgical penetration device as claimed in claim 12 wherein the nontapered section of said light transmission and imaging member is substantially circular in cross section.
14. The surgical penetration device as claimed in claim 12 wherein the predetermined amount of said nontapered section is integrally joined to said elongated member at said first end of said elongated member.
15. The surgical penetration device as claimed in claim 1 wherein said light transmission and imaging member is formed of glass.
16. The surgical penetration device as claimed in claim 1 wherein said light transmission and imaging member is formed of plastic.
17. The surgical penetration device as claimed in claim 1 wherein said elongated member has a second end opposite said first end, and a handle member being provided proximate said second end to facilitate manipulation of said elongated member.
18. The surgical penetration device as claimed in claim 1 including handle means joined to said elongated member to permit one-handed manipulation of said elongated member and to permit the same one hand to simultaneously exert manual pressure on said elongated member in the direction of said light transmission and imaging member for surgical insertion of said light transmission and imaging member through human flesh into a body cavity.
19. The surgical penetration device as claimed in claim 18, said handle means extending away from the elongated member to avoid interference with said means for containing the conventional lighting means and the conventional light image receiving means.
20. The surgical penetration device as claimed in claim 18 wherein said handle means has a thumb rest for the right and left hands to permit use of said handle means with either hand.
21. The surgical penetration device as claimed in claim 18 wherein said handle means is sufficiently elongated to permit gripping by all of the fingers.
22. The surgical penetration device as claimed in claim 1 wherein said inflexible elongated member is tubular with a hollow space, said hollow space in said inflexible elongated member extending to said light transmission and imaging member, and said hollow space constituting the containing means for containing the conventional lighting means and the conventional light image receiving means in the form of a conventional telescope.
23. The surgical penetration device as claimed in claim 1 wherein the light transmission and imaging member forms a closure at the first end of said inflexible elongated member.
24. A method of visualizing insertion of a surgical device through flesh into a body cavity comprising the steps of:
a) providing a novel hollow trocar with a tubular body and a light transmission and imaging member with a cutting member for piercing human flesh for surgical insertion of the light transmission and imaging member through human flesh, b) joining said light transmission and imaging member to one end of said tubular body formed of a biocompatible material, c) slidably locating a conventional lighting means and a conventional light image receiving means in the form of a conventional light telescope in said hollow trocar proximate said light transmission and imaging member to enable light from the lighting means to project outwardly away from said light transmission and imaging member and to permit the light image receiving means to receive light images that pass from outside said light transmission and imaging member through said light transmission and imaging member while said light transmission and imaging member is being inserted through the flesh into a body cavity, whereby said light transmission and imaging member provides a receivable image of the flesh and body cavity being entered.
a) providing a novel hollow trocar with a tubular body and a light transmission and imaging member with a cutting member for piercing human flesh for surgical insertion of the light transmission and imaging member through human flesh, b) joining said light transmission and imaging member to one end of said tubular body formed of a biocompatible material, c) slidably locating a conventional lighting means and a conventional light image receiving means in the form of a conventional light telescope in said hollow trocar proximate said light transmission and imaging member to enable light from the lighting means to project outwardly away from said light transmission and imaging member and to permit the light image receiving means to receive light images that pass from outside said light transmission and imaging member through said light transmission and imaging member while said light transmission and imaging member is being inserted through the flesh into a body cavity, whereby said light transmission and imaging member provides a receivable image of the flesh and body cavity being entered.
25. The method of claim 24 including slidably locating said hollow trocar with said light transmission and imaging member in a sleeve and fixing the position of said hollow trocar relative to the sleeve such that substantially only the light transmission and imaging member with the cutting member projects from one end of the sleeve to permit insertion of the sleeve with the light transmission and imaging member through the flesh into a body cavity.
26. The method of claim 24 including monitoring the light images received by the light image receiving means on a video screen while the light transmission and imaging member is being inserted through the flesh into a body cavity to obtain continuous video aided visual imaging of the internal location of the light transmission and imaging member during such insertion.
27. The method of claim 26 including slidably removing the hollow trocar with the conventional light telescope from said sleeve, while said sleeve remains inserted through the flesh into a body cavity.
28. The method of claim 27 including reinserting the conventional light telescope in the sleeve, without the hollow trocar.
29. The method of claim 24 including joining a handle member to the tubular body proximate an opposite end of the tubular body to manipulate said trocar and to exert manual pressure on said trocar in the direction of said light transmission and imaging member for surgical insertion of said light transmission and imaging member through human flesh into a body cavity.
Applications Claiming Priority (8)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| PCT/US1993/011109 WO1994011040A1 (en) | 1992-11-17 | 1993-11-16 | Visually directed trocar and method |
| USPCT/US93/11109 | 1993-11-16 | ||
| US08/153,625 | 1993-11-17 | ||
| US08/153,628 US5551947A (en) | 1992-11-17 | 1993-11-17 | Visually directed trocar for laparoscopic surgical procedures and method of using same |
| US08/153,628 | 1993-11-17 | ||
| US08/153,625 US5380291A (en) | 1992-11-17 | 1993-11-17 | Visually directed trocar for laparoscopic surgical procedures and method of using same |
| US08/153,632 US5376076A (en) | 1992-11-17 | 1993-11-17 | Visually directed trocar for laparoscopic surgical procedures and method of using same |
| US08/153,632 | 1993-11-17 |
Publications (2)
| Publication Number | Publication Date |
|---|---|
| CA2176565A1 CA2176565A1 (en) | 1995-05-26 |
| CA2176565C true CA2176565C (en) | 1997-03-18 |
Family
ID=27492634
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CA002176565A Expired - Lifetime CA2176565C (en) | 1993-11-16 | 1994-07-29 | Visually directed trocar and method |
Country Status (6)
| Country | Link |
|---|---|
| EP (1) | EP0746247B1 (en) |
| AU (1) | AU693468B2 (en) |
| CA (1) | CA2176565C (en) |
| DE (1) | DE69433986T2 (en) |
| ES (1) | ES2227530T3 (en) |
| WO (1) | WO1995013751A1 (en) |
Families Citing this family (8)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US5685820A (en) * | 1990-11-06 | 1997-11-11 | Partomed Medizintechnik Gmbh | Instrument for the penetration of body tissue |
| US7470230B2 (en) | 2005-03-31 | 2008-12-30 | Tyco Healthcare Group Lp | Optical obturator |
| US8202290B2 (en) | 2007-04-17 | 2012-06-19 | Tyco Healthcare Group Lp | Visual obturator with handle |
| US8192353B2 (en) * | 2007-10-05 | 2012-06-05 | Tyco Healthcare Group Lp | Visual obturator |
| US9226774B2 (en) | 2009-12-17 | 2016-01-05 | Covidien Lp | Visual obturator with tip openings |
| US10463399B2 (en) * | 2014-11-06 | 2019-11-05 | Asimion Inc. | Visually assisted entry of a Veress needle with a tapered videoscope for microlaparoscopy |
| EP3661412A4 (en) | 2017-08-04 | 2021-03-31 | Brigham and Women's Hospital, Inc. | Veress-type needles with illuminated guidance and safety features |
| US11382662B2 (en) | 2017-08-04 | 2022-07-12 | The Brigham And Women's Hospital, Inc. | Trocars and veress-type needles with illuminated guidance and safety features |
Family Cites Families (4)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| DK131542C (en) * | 1974-02-06 | 1976-02-09 | Akad Tekn Videnskaber | SURGICAL INSTRUMENT FOR SAMPLING BIOLOGICAL SAMPLES |
| US4601710B1 (en) * | 1983-08-24 | 1998-05-05 | United States Surgical Corp | Trocar assembly |
| DE4035146A1 (en) * | 1990-11-06 | 1992-05-07 | Riek Siegfried | INSTRUMENT FOR PENETRATING BODY TISSUE |
| US5334150A (en) * | 1992-11-17 | 1994-08-02 | Kaali Steven G | Visually directed trocar for laparoscopic surgical procedures and method of using same |
-
1994
- 1994-07-29 DE DE69433986T patent/DE69433986T2/en not_active Expired - Lifetime
- 1994-07-29 ES ES94925159T patent/ES2227530T3/en not_active Expired - Lifetime
- 1994-07-29 EP EP94925159A patent/EP0746247B1/en not_active Expired - Lifetime
- 1994-07-29 AU AU75183/94A patent/AU693468B2/en not_active Expired
- 1994-07-29 WO PCT/US1994/008683 patent/WO1995013751A1/en active IP Right Grant
- 1994-07-29 CA CA002176565A patent/CA2176565C/en not_active Expired - Lifetime
Also Published As
| Publication number | Publication date |
|---|---|
| EP0746247B1 (en) | 2004-09-08 |
| EP0746247A1 (en) | 1996-12-11 |
| ES2227530T3 (en) | 2005-04-01 |
| DE69433986T2 (en) | 2005-02-03 |
| WO1995013751A1 (en) | 1995-05-26 |
| AU7518394A (en) | 1995-06-06 |
| DE69433986D1 (en) | 2004-10-14 |
| AU693468B2 (en) | 1998-07-02 |
| EP0746247A4 (en) | 1997-11-19 |
| CA2176565A1 (en) | 1995-05-26 |
Similar Documents
| Publication | Publication Date | Title |
|---|---|---|
| US5551947A (en) | Visually directed trocar for laparoscopic surgical procedures and method of using same | |
| US5720761A (en) | Visually directed trocar and method | |
| US5609562A (en) | Visually directed trocar and method | |
| WO1994011040B1 (en) | Visually directed trocar and method | |
| US6908427B2 (en) | Flexible endoscope capsule | |
| AU2007338691B2 (en) | Surgical visual obturator | |
| US6685630B2 (en) | Optical trocar | |
| US5323766A (en) | Illuminating endo-photocoagulation probe | |
| US4493323A (en) | Suturing device and method for using same | |
| US5976168A (en) | Tissue separation cannula | |
| CA2327268C (en) | Endoscopic instrumentation with working channel | |
| CN108430356A (en) | The vision auxiliary of veress needle with the taper video-endoscope for Micro laparoscopic enters | |
| US20060058585A1 (en) | Medical instrument set and method for creating a surgical operating space in operations on the jaw | |
| JPH04221538A (en) | Device for forming hole | |
| JPH07178100A (en) | Apparatus with forceps-form needle holder | |
| EP0912139A1 (en) | Tissue separation cannula with dissection probe and method | |
| US7060028B2 (en) | Endoilluminator | |
| CA2176565C (en) | Visually directed trocar and method | |
| WO1995020341A1 (en) | Endoscope with insertable tool | |
| JPH0565180B2 (en) | ||
| DE69732218T2 (en) | Circumference illumination of anatomical transitions |
Legal Events
| Date | Code | Title | Description |
|---|---|---|---|
| EEER | Examination request | ||
| MKEX | Expiry |
Effective date: 20140729 |